. And in some selected patients following tests are also
done –Lumbar puncture, HIV Serology & brain biopsy can be performed.

2. URINARY INCONTINENCE

It is defined as the involuntary passage of urine through
urethral orifice. It is common in females.

Urinary incontinence may occur with a normal urinary tract
for example with poor cognition or poor mobility or during hospitalization or
acute illness in older people.

Some of the urodynamic abnormalities found in patients with
urinary incontinence are mentioned below-

1. Stress incontinence- in this condition as such the
patient remains normal but during the act of coughing, sneezing urine leaks as
there is passive increase in the vesical pressure & which is more than the
urethral pressure. This is most commonly found in females after childbirth and
rarely in males.

2. Urge incontinence- Sometimes during filling the detrusor
muscle contracts which leads to increased vesical pressure and if this vesical
pressure is greater than the urethral pressure, leaking occurs . The incidence
of the condition increases with age.

3. Overflow incontinence – In this case the bladder is full
and there is no contraction of detrusor muscle but a minimum quantity of
abdomen & vesical pressure result in urine leakage.

4. Prostatic obstruction – In this condition the storage
phase is normal but there is a problem in voiding phase. During the act of
voiding of urine detrusor muscle contracts which results in increased vesical
pressure but besides this increased vesical pressure there is a poor/ wavy flow
of urine because of obstruction in the prostatic urethra also.

Cause of Urinary
Incontinence

Causes of urinary incontinence van be classified as follows-

1. Established – This includes various diseases such as
cerebral or spinal cord lesion , stroke, dementia, bladder diseases,
parkinsonism & myelopathy.

Osteoporosis is defined as a group of bone disorders in which
the absolute bone mass is less than normal & which result into decrease in
micro – architecture leading to increased bone fragility & risk. The
mineral- matrix ratio is reduced. It usually remains silent or asymptomatic
until a fracture occurs. In India around 35% post-menopausal women are at risk
of developing osteoporosis.

Types Of Osteoporosis

Primary osteoporosis this can be classified into the
following

. Post-menopausal (type-I),senile ( type-II)

.Idiopathic which is further divided into juvenile & in
adults (premenopausal)

As the eole grow both the sexes tend to lose on the bone
mass but the bone mass loss is accelerated in females during their menopausal
time and this is known as age-related osteoporosis or involutional
osteoporosis. This can be divided into following types-

Type I (postmenopausal) –This occurs in the age group of
51-70 yrs with a female: male as 5:2

Mainly there is an accelerated bone loss from the trabecular
region & vertebrae (crush) & distal radius are the fractured sites are.
There is a decrease in calcium absorption , parathyroid function & renal
conversion of 25 (OH) D to 1,25 (OH)2D. The main cause of this type of
osteoporosis arew the factors relatedto
menopause.

Symptoms Of Osteoporosis

Mostly the patients remain asymptomatic until they develop a
complicating fracture which can be caused by slightest trauma. Most common
sites for fracture are hip, humerus, ribs & wrists.

Symptoms include- PPain in the back , deformity of the spine
(Kyphosis) & loss of height, pain usually results from collapse of the
vertebral bodies, especially in lower dorsal and upper lumbar region.

Diagnosis

In earlier days the diagnosis was made after the manifestation
of fracture in old age. But now the diagnosis can be made easily by-

Bone densitometry which includes

. Dual energy X-Rayabsorptiometry

. Quantitative
computed tomography

. Quantitative ultrasound

. Radiographic absorptiometry

.Single energy X-Ray absorptiometry

Interpretation of result is done in terms of T- score or
Z-score. T-score represent bone mass of patient compared to mean peak bone mass
& Z-sore compares the patient bone mineral density (BMD) with the mean BMD
of the person of same age.

According to the WHO osteoporosis is diagnosed using T-score
as-

1. BMD within 1.0 SD –Normal

2. BMD between 1.0 SD or more – Osteopaenia

3. BMD below 2.5 SD or more – Osteoporosis

4. BMD beyond 2.5 SD with one or more fragility fracture-
severe osteoporosis.

X-RAY is useful when 30-50% bone mass is lost. The
radiological changes are more market in bones of the axial skeleton &
consist of loss of bone density, decrease in number & size of the
trabeculaeand thinning of the cortex.

Osteoporosis can be prevented or early treatment can be
opted in order to prevent the disease by using following measures-

. Calcium intake 1.0-1.5 g/ day

. Moderate phosphorous intake

. Moderate Vit. D intake

. Appropriate exercise programmed

Avoidance of alcohol & cigarette

.Periodic assessment of skeletal status

OTHER TYPES OF OSTEOPOROSIS

Idiopathic osteoporosis

This is found in children, younger men or premenopausal
women. Juvenile osteoporosis, rare condition is found in age group between 8-14
yrs. Onset is usually abrupt with appearance of bone pains and fracture after
minimal trauma .Investigation reveal malabsorption of calcium and/or increased
urinary calcium loss.

Steroid induced osteoporosis

Sometimes osteoporosis is seen with some other disease such
as Cushing’s syndrome etc. Glucocorticoid excess can result in increased rate
of bone desorption and decreased rate of bone formation.

5. MENOPAUSE

Menopause occurs in both males (Andropause) & females
(Menopause)

Andropause

Andropause occurs in males due to decline of androgenic
hormone with ageing It is not universal and but is a gradual rocess which is not
associated with any other complaint as in females. There is a decrease in
testosterone and serum inhibin with an increase in sex hormone binding globulin
(SHBG).Some of symptoms which usually seen are fatigue, depression, loss if
energy and increased risk of cardiovascular problems and osteoporosis.

Menopause

Menopause is defined as the tie of cassation of ovarian
function resulting in permanent amenorrhea. Menopause usually occurs between
the age group of 45 and50 yrs.

Menopause after the age of 50 indicates the good health and
nutrition of the female but late menopause is also found in females with
uterine fibroids and who have a risk of endometrial cancer. If the menopause
occurs before the age of 40 then it is known as premature menopause.

Risk factors for menopause

There are certain factors which can become risk factors for
menopause related diseases are mentioned below-

. Early menopause

. Surgical menopause or radiation

. Chemotherapy especially alkalytic agents

.Smoking , caffeine , alcohol

.Family history of menopausal diseases

Drugs related like heparin , corticosteroids and clomiphene
etc. If given for a prolonged period then can lead to estragon deficiency.

Symptoms of menopause

Menstrual flow can cases in the following three ways-

. Sudden cassation

. Gradual diminution in the amount of blood loss with each
regular period until menstruation stops

.Gradual increase in the spacing of the periods until they
cease for at least a period of one year.

symptoms relating to the menopause are mentioned below-

. Hot flushes – They are the waves of vasodilatation which
effect the face and neck for 2-5 minutes and occur at several times in a day .
Hot flushes lead to sweating . These flushes are also preceded by headaches.

. Palpitation

. Mild depression due to disturbed sleep

. Irritability

.Lack of concentration

Various other symptoms include-

. Neurological – Vasomotor symptoms , par aesthesia which
causes a sensation of pins and needles in various parts.

. Urinary symptoms – Urethral carbuncle dysuria with or
without infection, urge and stress incontinence like symptoms are seen because
of the estrogen deficiency.

Various sort of urinary symptoms are clubbed together and
are known as urethral syndrome.

Sudden redness in the face with a wild look, especially and during
menopause.

ALUMINA

Prostatic discharge. Flowing of prostate fluid during difficult
stools. There is fullness and enlargement of the prostate gland & various
disturbances of the prostate, with sensation of fullness in the perineum.

FEMALE GENITALIA/SEX –
MENOPAUSE

GENERALS- OLD AGE- old
people ;in

AMYLENUM NITROSUM

For nervous , sensitive , plethoric women, during or after the menopause.

Sensation of being possessed
of two opposing wills; is inclined to laugh when he ought to be serious,
& does not incline to laugh when tempted by what is ludicrous;
action stupid & childish; rapid loss of self reliance, memory &
mental vigor; incipient dementia.

APIS MELLIFICA

Incontinenceof urine, with
great irritation of the parts; can scarcely retain the urine a moment, &
when passed scalds severely; frequent, painful, scanty, bloody.

ARNICA MONTANA

Retention or incontinence of urine after labor(op.)

ARSENICUM ALBUM

Incontinence of urine , which escapes almost involuntarily, even at
night, in bed .

Spine weak, disposed to curvatures , especially to the left; unable
to support body ; neck weak, unable to support head

It is especially indicated in tardy
dentition and troubles incident to that period, bone disease non-union
of fractured bones, and the anemia’s after acute diseases and chronic
wasting diseases.

CIMICIFUGA RACEMOSA

Uneasy, restless feeling in limbs.

Aching in limbs and muscular soreness.

Rheumatism affecting the
belly of muscles, especially large muscles.

CAPSICUM ANNUUM

Uterine hemorrhage near the menopause, with nausea. PROSTATE GLAND-
COMPLAINTS of prostate

CONIUM MACULATUM

Great difficulty in voiding urine; flow intermits, then flow again;
prostatic or uterine affections. Discharge of prostatic fluid . It is a well
indicated medicine for urinary complaints arising from enlarged prostate and
uterine affections.

Frequently called for in acute symptoms of the bladder and urethra,
with enlarged prostate, the faces are flattened. Menopausal and post- natal
hormonal changes can also upset pulsatilla’s delicate emotional balance. She
is listed in Kent’s repertory under the rubrics ‘Insanity-puerperal’
,and‘Insanity- puerperal’ , but I am
sure that emotional liability at these times is far more common than insanity
in pulsatilla women . Affections of the bladder and prostate gland

SECALE CORNUTUM

Enuresis: of old people ; urine pale , watery, or bloody; urine
suppressed.